Conflict and Climate Factors and the Risk of Child Acute Malnutrition Among Children Aged 24-59 Months: A Comparative Analysis of Kenya, Nigeria, and Uganda.

Acute malnutrition affects a sizeable number of young children around the world, with serious repercussions for mortality and morbidity. Among the top priorities in addressing this problem are to anticipate which children tend to be susceptible and where and when crises of high prevalence rates would be likely to arise. In this article, we highlight the potential role of conflict and climate conditions as risk factors for acute malnutrition, while also assessing other vulnerabilities at the individual- and household-levels. Existing research reflects these features selectively, whereas we incorporate all the features into the same study. The empirical analysis relies on integration of health, conflict, and environmental data at multiple scales of observation to focuses on how local conflict and climate factors relate to an individual child's health. The centerpiece of the analysis is data from the Demographic and Health Surveys conducted in several different cross-sectional waves covering 2003-2016 in Kenya, Nigeria, and Uganda. The results obtained from multi-level statistical models indicate that in Kenya and Nigeria, conflict is associated with lower weight-for-height scores among children, even after accounting for individual-level and climate factors. In Nigeria and Kenya, conflict lagged 1-3 months and occurring within the growing season tends to reduce WHZ scores. In Uganda, however, weight-for-height scores are primarily associated with individual-level and household-level conditions and demonstrate little association with conflict or climate factors. The findings are valuable to guide humanitarian policymakers and practitioners in effective and efficient targeting of attention, interventions, and resources that lessen burdens of acute malnutrition in countries prone to conflict and climate shocks.

Considering climate and conflict conditions together to improve interventions that prevent child acute malnutrition.

Despite early warning signs about threats to food security, humanitarian interventions often lag behind these warning signs. Climate and conflict conditions are among the most important factors preceding food system failures and malnutrition crises around the world. Research shows how conflict and climate conditions can upend functional food and economic systems, but this research does not address the severe health impacts of these conditions on infants and young children. Translating quantitative research findings into humanitarian interventions requires geographical detail, resulting in location-specific alerts of risks of food insecurity. We describe how the use of readily available, spatially referenced quantitative data can support targeted interventions for nutrition resiliency. Effective humanitarian programmes for targeted nutrition interventions require real-time datasets on food security drivers and models that can provide actionable guidance to mitigate negative impacts of conflict and climate conditions on the people most susceptible to food insecurity. Although treatment of acute malnutrition is important, treating existing malnutrition is not enough. Instead, action to prevent acute malnutrition should be taken to minimise suffering and to maximise wellbeing, particularly in contexts prone to worsening climate and conflict conditions.

Visualizing trends in food security across Africa, 2009-2020: Data and animations at a grid-cell level.

The Famine Early Warning Systems Network (FEWS NET) has been appraising food security in numerous countries around the world since 1985. Multiple times per year, FEWS NET reports scores for current situation assessments and future projections of food security. The scores are measured on a five-level index scale and gauged for the geographic units of livelihood zones. These zones vary in size and do not remain static, which complicates comparison of food security within and across countries and over time. To facilitate such analysis and interoperability with other sources, we transformed available raw data to the units of geospatial grid-cells that have a uniform, static resolution of 0.5° × 0.5°, a common format of data used in research across diverse disciplines. FEWS NET provides public online access to shapefiles reflecting reports back to 2009. Separate shapefiles capture assessments and projections, with further delineation by the index score. Each shapefile can comprise a complex (multi)polygon, without clear differentiation among livelihood zones. Overlaying a geospatial grid allows disaggregation of the (multi)polygons to standard units. We performed the transformation to grid-cells on the shapefiles for all 25 countries (including Yemen) that FEWS NET tracked within regional groupings of East, Southern, and West Africa from July 2009-October 2020. For each report cycle, each grid-cell was assigned scores of the assessment and near-term and medium-term projections, based on the raw data for the corresponding livelihood zone. In addition, we calculated a value of bias in medium-term projections relative to subsequent assessments, which can be used as a metric for validation of accuracy. This article provides access to the grid-cell data on assessment and projection scores and bias values. In addition, we present time-lapse animated maps as tools to visualize historical patterns and trends in these indicators across Africa. Our related research article employed the grid-cell data to evaluate the accuracy of FEWS NET projections, including as a function of variation in humanitarian assistance, climate conditions, and violent conflict (Backer and Billing [1]). Researchers can likewise use the grid-cell data to conduct further validation of food security projections and to examine the relationship of assessments and projections to potential drivers and consequences. The data and animations are also valuable to stakeholders throughout the international community seeking to learn and disseminate knowledge about the tendencies of food security projections on a broad scale.

Cystitis: symptomatology in women with suspected uncomplicated urinary tract infection.

BACKGROUND: Although cystitis in women is very common in general practice, its evolution in symptoms has not been clearly studied. Qualitative research has pointed to other than the classic symptomatology. METHODS: This was a prospective observational study of the symptomatology at presentation and the evolution of the symptoms in treated women with suspected uncomplicated urinary tract infection (UTI). Women consulting their general practitioner (GP) for dysuria, urgency, or frequency produced a urine sample (for bacteriologic processing) and kept a diary until the end of the symptoms. Exclusion criteria included complaints >1 week, fever, vaginal discharge, and known pathology. RESULTS: Of the 300 asked to participate, 148 (49%) returned the diary. Although none of the patients developed acute pyelonephritis, a substantial number of the women had such complaints as feeling feverish (33% in culture-positive group, 38% in culture-negative group), back pains (44% vs. 56%), and feeling weak and tired (71% vs. 65%). Differences between the culture-positive and culture-negative groups were not statistically significant except for the duration of symptoms, which was shorter in the culture-positive group (4 vs. 6 days). More severe symptoms at inclusion were correlated with a longer duration of these symptoms. CONCLUSIONS: The spectrum of complaints in women with suspected uncomplicated UTI is broad and comprises a number of symptoms usually associated with an upper UTI. The occurrence of these symptoms should not automatically prompt GPs to prescribe broad-spectrum antibiotics. Moreover, the duration of symptoms exceeding the recommended duration of antibiotic therapy does not indicate therapy failure and, thus, the need for changing antibiotic therapy.

Evolution of bacterial susceptibility pattern of Escherichia coli in uncomplicated urinary tract infections in a country with high antibiotic consumption: a comparison of two surveys with a 10 year interval.

OBJECTIVES: For the empirical treatment of cystitis, clinicians are often guided by susceptibility data taken from urinary samples that sent to regional microbiological laboratories, which are not representatives for uncomplicated urinary tract infections (UTIs). To offer adequate recommendations, the distribution and susceptibility pattern of uropathogens in uncomplicated UTIs in women were compared with those obtained 10 years ago in our uropathogen surveillance in a primary healthcare setting. METHODS: Sixty-six general practitioners in the region of the city of Ghent were asked to inoculate a dipslide with midstream urine from every adult female patient with complaints suggestive for cystitis, during a period of 1 year. The dipslides were further processed in a central microbiological laboratory, where counting, identification and susceptibility testing were performed. RESULTS: Three hundred specimens were collected, of which 187 (62.3%) yielded a positive culture of 10(5) cfu/mL. In the age group of 18-54 years, Escherichia coli was the most frequently isolated uropathogen (77.5%), followed by Staphylococcus saprophyticus (13.5%) and Proteus spp. (2.7%). There were no statistically significant differences when compared with the data from 1996. In 2006, susceptibility of E. coli to nitrofurantoin was 100%, to quinolones 100%, to ampicillin 62.8% and to co-trimoxazole 86%, compared with 99.3%, 99.3%, 73.2% and 83.3%, respectively, in 1996 (no statistically significant differences). CONCLUSIONS: Over a period of 10 years, a systematic surveillance of uropathogens in female patients with uncomplicated UTI in general practice could not demonstrate a significant change in species distribution or antimicrobial susceptibility.

Guidelines, evidence, and cultural factors.

OBJECTIVE: To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. DESIGN: Descriptive study with a qualitative analysis of authors' reasons for recommendations. MATERIAL: Guidelines for general practitioners published 1999-2000 from Germany, The Netherlands, Norway, and Belgium on diagnosis and treatment of uncomplicated cystitis. Opinions of the guideline authors on the influence of local factors on the recommendations were collected before and after feedback on the differences between the guidelines. RESULTS: Few cited references were shared between the guidelines, and recommendations differed substantially, especially on diagnostic strategies and referral criteria. The authors attributed parts of the differences to local factors. German and Belgian authors stressed the need for safety in their diagnostic and therapeutic approach, while Dutch authors felt confident in their gatekeeper role and the Norwegian authors mainly relied on "the evidence". Dutch and Belgian authors perceived patients to hold power, German authors referred to the power of the sub-specialists, while the Norwegians aimed to share power with the patient through a patient-centred approach. CONCLUSION: There are substantial differences even between high-standard guidelines on the same well-defined clinical entity. The selection of literature data, and diagnostic and therapeutic recommendations, seemed to be influenced by such cultural aspects as habits, the patient's expectations, and the structure of the healthcare system.